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The "Moon Shots Program" will focus on genomics to understand the genetic and molecular basis of cancers and to identify patient-specific treatments by making genomics routine in cancer care. Tumor analysis coupled with clinical trial literature search to try and match therapies to patient-specific biomarker information to generate a treatment approach. The problem is that genomics cannot predict for disease or patient-specific drug effects (drug selection).
No technology is more well suited to the investigation and simultaneous analysis of the relationships between patient-specific target molecules, cell functions and cell sub-populations than cytometry and Cytometric analysis of cell phenotype and function provides a very comprehensive overview of this ever-broadening field. It doesn't dismiss DNA testing, it uses all the information, measuring the interaction of the entire genome, to design the best treatment for each individual.
Replacing the one-size-fits-all paradigm with another one-size-fits-all paradigm isn't making personalized cancer therapy any more cost effective. Targeted therapy is still a one-size-fits-all model. Finding what targeted therapies would work for what cancers is very difficult. A lot of trial-and-error goes along trying to find out.
Molecular profiling measures the expression of protein only in the "resting" state, prior to drug exposure. There is no single gene whose expression accurately predicts clinical outcome. Efforts to administer targeted therapies in randomly selected candidates often result in low response rates at significant toxicity and cost.
Molecular profiling is based on the same clinical literature search (population study), which tries to match therapies to patient-specific biomarker information to generate a treatment approach. This is not really personalized medicine, but just a refinement of statistical data. In other words, information that may help when considering "potential" treatment options (theoretical analysis). It's never even measured against your actual cancer cells.
All the molecular profiling studies tell us is whether or not the cancer cells are potentially susceptible to a mechanism of attack. They don't tell you if one drug is better or worse than another drug which may target a certain mechanism. The cell is a system, an integrated, interacting network of genes, proteins and other cellular constituents that produce functions. You need to analyze the systems' response to drug treatment, not just one mechanism of attack.
None of the targeted drugs are cures, they are life savers by being a life lengthener. Targeted therapy is what is used to stabilize the disease rather than cure it. Will patients have to take the drugs indefinitely? How is that cost effective?
Most targeted drugs do not directly kill cancer cells, they just stop the growth of tumors. Therefore, patients must receive treatment for prolonged periods, and over time, they often develop secondary resistance. They eventually succumb to treatment resistance or disease recurrence.
To beat down individual cancer mortality, an oncologist needs to target all the many cancers that make up individual cancer, the dozens of different mechanisms that cells use to proliferate and spread. That is the leading edge of personalized research and treatment, determining how an individual's tumor cells work and hitting those pathways with multiple drugs, simultaneously or sequentially, each chosen because it targets one of those growth, replication and angiogenesis mechanisms.
Trying to mate a notoriously heterogeneous disease into one-size-fits-all treatments is disingenuous to all who are inflicted with it. And the criticism remains: All of the clinical trial resources have gone toward driving a square peg (one-size-fits-all chemotherapy) into a round hole (notoriously heterogeneous disease).
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